Evidence map›Paper›PMID 40581723›Full record

ArticleJournal of neuro-oncology2025

Outcomes of leptomeningeal disease after only vertebral osseous metastases: a real-world analysis using the TriNetX database.

Ryan Gensler, Yuanxuan Xia, Melanie Alfonzo Horowitz, Mostafa Abdulrahim, Nathan Hyson, Kristin Redmond, Daniel Lubelski, Nicholas Theodore, David Kamson, Chetan Bettegowda and 1 more

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Article in Journal of neuro-oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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0cells of the map it votes in
1citing papers in PubMed
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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

11 authors.

Ryan GenslerJohns Hopkins University School of Medicine, Baltimore, MD, USA. rgensle3@jh.edu.
Yuanxuan XiaDepartment of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Melanie Alfonzo HorowitzJohns Hopkins University School of Medicine, Baltimore, MD, USA.
Mostafa AbdulrahimJohns Hopkins University School of Medicine, Baltimore, MD, USA.
Nathan HysonDepartment of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD, USA.
Kristin RedmondDepartment of Radiation Oncology, Johns Hopkins Hospital, Baltimore, MD, USA.
Daniel LubelskiDepartment of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Nicholas TheodoreDepartment of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA.
David KamsonDepartment of Radiation Oncology, Johns Hopkins Hospital, Baltimore, MD, USA.
Chetan BettegowdaDepartment of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Yuxuan WangDepartment of Oncology, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21287, USA. yuxuan.wang@jhmi.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeLeptomeningeal disease (LMD) is a morbid complication of systemic cancer typically associated with brain metastases. However, vertebral bone metastases may also serve as a route for cerebrospinal fluid spread, though this pathway is less characterized. This study aims to determine the incidence, timing, and outcomes of LMD in patients with vertebral metastases in the absence of brain or other systemic metastases, using a large real-world database.

methodsUsing the TriNetX global health research network (n = 133 million), we identified 7887 adult patients with vertebral metastases from common solid tumors (lung, breast, prostate, colorectal, renal, melanoma, thyroid) who had no brain metastases or other potential sources of LMD. Patients were followed to identify development of LMD, and cohorts were compared based on metastatic pathways and clinical outcomes.

resultsAmong 7887 patients with vertebral metastases, 144 (1.8%) developed LMD without prior or concurrent brain or systemic metastases, isolating the spine as the sole source. Breast cancer had the highest LMD rate (36.8%), followed by lung (20.8%), prostate (18.8%), and colorectal (11.1%). Median time from vertebral metastasis to LMD was 97.5 days (IQR 17-550), longer than the 50-day median (IQR 12-182) in patients with brain metastases before LMD (p < 0.001). Patients with vertebral metastases alone developed LMD significantly earlier than those with other prior metastases (median 97.5 vs. 250 days, IQR 100-775, p < 0.01). LMD was associated with shorter overall survival (median 170 vs. 370 days, p = 0.0006; HR 0.61, 95% CI 0.46-0.81), particularly in breast cancer (170 vs. 1001 days, p < 0.01). LMD patients were more likely to require hospice or palliative care (39.6% vs. 22.2%, p < 0.001), while non-LMD patients more often reported pain (67.1% vs. 52.4%, p = 0.0113) and emotional distress (45.8% vs. 26.4%, p = 0.007). Survival after LMD diagnosis was similarly poor regardless of metastatic pathway (p = 0.966).

conclusionVertebral metastases can serve as an underrecognized route of LMD spread, even in the absence of brain or other systemic metastases. LMD following vertebral disease is associated with poor prognosis and increased palliative care utilization. These findings underscore the need for heightened clinical vigilance for LMD in patients with spinal metastases.

Indexed as

Meningeal CarcinomatosisMeningeal NeoplasmsSpinal NeoplasmsAdultAgedAged, 80 and overDatabases, FactualFemaleFollow-Up StudiesHumansIncidenceMaleMiddle AgedPrognosisSurvival RateCentral nervous system disseminationLeptomeningeal metastasisReal-world data analysisSurvival and quality-of-life outcomesTriNetX health research networkVertebral osseous metastases

Identifiers

PMID40581723

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.